Archived: Rose House

Updated 22 March 2022

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.

Inspection team

The inspection was completed over two site visits. Each visit was completed by two inspectors. In total three inspectors participated in this inspection.

Service and service type

Rose House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service did not have a manager registered with the Care Quality Commission. A manager had been appointed to the service in July 2021 and intended to apply to the commission to become registered. Registered managers and providers are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

This inspection was unannounced.

What we did before inspection

We reviewed information we had received about the service since the last inspection. The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

During the inspection

We met and spoke with the person living at Rose House. We spoke with four members of staff, the service’s manager and the provider’s Nominated Individual. We observed staff as they supported the person with their routines on both days of the inspection. This helped us to understand their experience of living at Rose House.

We reviewed a range of records. This included care records and medication records. We looked at a range of records relating to the management of the service.

After the inspection

We reviewed documents requested during the inspection and completed an analysis of staffing levels in place in the month prior to the inspection. We also spoke with two of the person’s relatives to gather their feedback on the service’s performance.

Updated 22 March 2022

About the service

Rose House is a residential care home providing personal care for up to two people with learning disabilities or autistic people. At the time of our inspection one person was using the service. It is part of the Spectrum (Devon and Cornwall Autistic Community Trust) group, a provider with 15 other similar services across Cornwall. The service is a detached two-storey property with an enclosed garden area at the rear. It is located in a rural area near Redruth, Cornwall.

People’s experience of using this service and what we found

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right Support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service had not made sufficient improvement since the last inspection to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

Right support: The service remained short staffed. This limited opportunities for the person to be supported to leave the service and meant it had not been possible for the person to engage with activities they were known to enjoy.

Right care: The person was subject to several restrictions to keep them safe. They were unable to access the service’s outdoor spaces or the community without significant staff support.

Right culture: The morale of the staff team had improved, and the person was now being supported to regain some skills they had lost. Relatives recognised staff had developed positive and supportive relationships with the person.

At this inspection we found that although there had been improvements in staffing arrangements since our last inspection, there were still insufficient staff available to meet the person’s support needs. This limited the person’s freedoms and ability to engage with activities.

Low staffing levels in combination with unsuitability of the service’s garden meant the person was unable to go outside without significant restrictions in place. This had prevented the person from engaging in some of the activities they enjoyed.

Fire risks had not been appropriately managed prior to this inspection. Firefighting equipment was serviced promptly once this issue had been identified during the first day of our inspection.

Some improvements had been made to the service’s environment since our last inspection. However, additional works were still necessary. In addition, at this inspection we found the person’s vehicle had not been regularly cleaned, and that a staff bathroom was poorly maintained and lacked appropriate equipment for the disposal of hand washing waste.

Staff now understood how to manage specific risks in relation to the person’s support needs and the manager recognised the importance of, where possible, reducing restrictions within the service.

Medicines were managed safely and staff understood their role in protecting people from abuse.

Staff had received appropriate training and support. They had developed the skills necessary to meet the person’s needs and were gaining confidence in their abilities.

Staff had spent time getting to know the person and now had a good understanding of the person’s individual needs and preferences. They spoke positively of the person they supported and relatives told us, “The staff have done well. [My relative] seems much more settled”.

Information on the person’s individual needs was fully documented. A shortened version of the person’s care plan had been developed to help new staff quickly gain some understanding of their specific needs. Staff now understood the person’s communication needs and were able to communicate effectively with the person. The manager was providing effective leadership to the staff team, whose morale had improved.

Relatives were complimentary of the manager and reported that the service communicated effectively with them. Visiting was actively encouraged and the person had been supported to maintain these relationships.

Although the provider’s systems had driven some improvements in the performance of the service, more work was needed to achieve compliance with the regulations.

We were assured that safe infection control practices were being followed in the service.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Inadequate (published 22 September 2021). At this inspection some improvement had been made but the provider was still in breach of regulations. The service is now rated inadequate in Safe, Responsive and Well led.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. At this inspection although improvements have been identified the service remains in breach breaches of the regulations relating to safety, staffing levels, opportunities to go outside, the environment of the service and governance. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.